This invention relates to the evaluation and treatment of fibrotic soft tissue and, more particularly, to specially designed instruments for use in the diagnosis of fibrotic soft tissue and performing soft tissue mobilization therapies on a living subject.
Soft tissue massage, including deep friction or cross fiber massage, has been known and practiced manually, that is, by hand, for some time. Friction massage is different from the superficial massage given in a longitudinal direction parallel to the vessels. Early pioneers of friction massage working in the 1930""s and ""40s include David Mennell and James Cyriax. Mennell advocated the use of specific massage movements called xe2x80x9cfrictionxe2x80x9d movements for conditions of inflammation and pathological deposits, as well as for recent ligament and muscle injuries. Cyriax later utilized a technique which he coined xe2x80x9cdeep friction massagexe2x80x9d to reach the musculoskeletal structure of ligament, tendon and muscle and provide therapeutic movement over a small area.
The purpose of deep massage or the mobilization of soft tissue is to maintain the mobility within soft tissue structures of ligament, tendon, and muscle, and to break down and/or prevent fibrous adhesions, commonly known as scar tissue, from forming. Soft tissue mobilization, when performed properly, is performed deep into the soft tissue and, in cross fiber massage, is applied transversely, that is, not in a longitudinal direction but in a direction across the tissue fibers, to the specific fibrotic soft tissue involved.
The biological healing of soft tissue injury is similar in muscle, tendon, and ligament. When soft tissue is stressed beyond its biomechanical yield strength, microtearing of the soft tissue under stress typically occurs. The human body""s normal response to the microtearing of collagen is inflammation. Scar tissue typically lays down in a three-dimensionally random fashion. This randomness can begin to affect the function (contractility and extensibility) of the surrounding tissues, which have a more uniform structure. Any loss of function may result in a reaggravation of the soft tissue during normal use and a vicious cycle of microtearing-inflammation-scarring.
The scientific reasons why soft tissue mobilization is successful are not fully understood. Yet, because this modality involves pressure and movement directed across or against the scar tissue, most theories are based on the effect of motion on healing tissue. It is well accepted today that early motion of injured tissue results in repair with reduced scar tissue formation or more improved alignment of the fibrosis and the soft tissue structure. In the early stages of healing, scar tissue is not as strong as in later stages, and it is thought that the remodeling phase of the inflammatory response depends on mechanical stimuli. Cyriax stated that transverse motion across the involved tissue and the resultant traumatic hyperemia were the chief healing factors. Cyriax further stated that moving across the fibers at a right angle would not injure the normal healing tissue but would prevent the formation of or cause the break down of abnormal scar tissue. Transverse friction moved the involved tissue, Cyriax held, while longitudinal friction affected the transportation of blood and lymph through the blood vessels.
In the acute stage of an early lesion within soft tissue, collagen (scar tissue) is immature. During the first 4 or so days, fibroblasts lay down a gel-like substance, but it takes up to 2 weeks for mature cross-links of the collagen to form. In the early stage of an acute lesion, it is reasonable to use only a light friction pressure. Light friction is primarily used to aid in the promotion of normal orientation of collagen, to maintain the mobility of the soft tissue, and to thereby prevent future scar tissue adhesions from forming. In the chronic stages, a deeper, stronger pressure is necessary.
To achieve mobilization of soft tissue, after the involved fibrotic soft tissue (muscle, tendon, or ligament) is located, typically through a combination of the practitioner""s review of the patient""s history and functional and physical diagnostic testing of the suspected fibrotic soft tissue areas, a practitioner can use a reinforced finger, i.e., middle finger over forefinger, that is just large enough to apply deep pressure across the injured fibrotic soft tissue. At times, because of the increased amount of pressure that must be applied or due to the density of the tissue being treated, it is advisable for the practitioner to employ a separate hand instrument. Such an instrument is also beneficial in preventing injury to the practitioner due to the prolonged period of time in which the increased pressure must be applied to the soft tissue areas of the patient.
Various tools are known for use in performing superficial massage which is given in a longitudinal direction parallel to the blood vessels to enhance blood circulation and the return of fluids to those areas of living subjects, particularly humans. For example, Courtin, U.S. Pat. No. 4,590,926, discloses a hand-held massager intended to provide effective massaging of various body parts.
Weeks, U.S. Pat. No. 1,769,872, describes a massage implement having a top surface, curved side surfaces, and a bottom surface. The curved sides and bottom are adapted to be held in the palm of the hand with the fingers arranged near a sharpened end, while the blunt end of the device is received in the palm of the hand. The top surface of the Weeks device is provided with a series of undulations intended to give the body parts massaged the same effect as though a manual massage is being performed. This device is primarily intended to be used about the face and neck.
Various other tools which have been disclosed in the prior art for use in massage include U.S. Pat. Nos. Des. 262,908; Des. 263,077; Des. 264,754; Des. 272,090; Des. 285,116; Des. 288,847; Des. 317,204; and Des. 323,035.
More recently, Warren Hammer, D. C., taught, inter alia, the use of a small rubber-tipped hand tool (commonly referred to as a xe2x80x9cT-barxe2x80x9d) to perform cross-friction massage of, particularly, plantar fascitis, plica, and patellar ligament lesions. See, Functional Soft Tissue Examination and Treatment by Manual Methods: The Extremities (Aspen Publications, Inc., Copyright 1991).
There continues to remain a need, however, for instruments of improved ergonomic design to better assist a practitioner not only in the treatment of fibrotic soft tissue by way of soft tissue mobilization therapies, but in its diagnosis as well.
This invention presents novel instruments intended for use in the diagnosis and treatment of fibrotic soft tissue through soft tissue mobilization therapies performed on, particularly, human patients.
A first embodiment of such an instrument provided by this invention includes a hand-held rigid unitary body comprising an upper handle portion, a lower massaging portion formed by a pair of sides converging from the upper handle portion and terminating along a tissue-engaging lower edge, and a peripheral edge extending about the circumference of the instrument. The circumferential peripheral edge of the instrument is defined by a curvilinear edge including a tissue-engaging concave leading edge and a convex rear edge disposed opposite from the leading edge. The sides of the instrument taper in one direction to form an inclined chisel-like surface leading to the concave leading edge. The instrument""s sides further taper toward one another from a central portion of the instrument longitudinally in both directions toward each end of the instrument to define, from a top plan view, an equiconvex shape. The body of the instrument has sufficient length to define a firmly graspable instrument that is longer than it is wide.
The leading edge of the instrument includes a concavely curved peripheral edge extending substantially from the upper edge of the instrument to the lower edge thereof. This concave leading edge is suitably dimensioned for providing effective mobilization of soft tissue of the upper or lower limbs of the human body. The convex rear edge of the instrument includes a convexly curved peripheral edge extending substantially from the upper edge to the lower edge of the instrument.
The upper handle portion of the instrument is defined by expanding upper portions of the sides of the instrument. These expanding upper portions lead to a generally rounded top surface and are preferably each provided with a non-slip surface.
In using this first embodiment, the concave leading edge of the instrument may be employed to engage and be moved along the skin of the patient to apply deep pressure to the underlying soft tissue. Alternatively, the rear edge or lower edge of the instrument may be utilized.
A second embodiment of a diagnostic and therapeutic instrument provided by this invention includes a hand-held rigid unitary body having a middle handle portion, an upper massaging portion, and a lower massaging portion opposite from the upper massaging portion. The upper massaging portion has a front surface, a rear surface, and a pair of curved lateral surfaces disposed opposite one another and extending between the front and rear surfaces. The front and rear surfaces converge and intersect one another at an uppermost point of the instrument to define a tissue-engaging blunt edge.
The lower massaging portion of this second instrument extends downwardly and outwardly from the middle handle portion such that it is offset laterally from the middle handle portion. The lower massaging portion terminates in an outwardly flared portion having a generally downwardly facing surface and a tissue-engaging curvilinear peripheral edge extending partially about the circumference of the downwardly facing surface. The downwardly facing surface and its peripheral edge are arranged in a common plane arranged at an acute included angle with respect to a longitudinal axis of the instrument. The downwardly facing surface is provided with a finger-receiving depression formed therein.
The middle handle portion has a generally tubular shape and a diameter tapering slightly from adjacent the lower massaging portion toward the upper massaging portion. The middle handle portion of the instrument body can also be provided with a non-slip surface to facilitate the firm grasping of the instrument.
In the use of this second embodiment, the upper blunt edge of the upper massaging portion of the instrument may be employed to engage and be moved along the skin of the patient to apply deep pressure to the underlying soft tissue. Alternatively, the curvilinear peripheral edge of the outwardly flared portion of the lower massaging portion of the instrument may be utilized. In this latter mode of use, the finger-receiving depression formed in the lower massaging portion is intended to receive the end or tip of a finger, e.g., thumb or index finger, of the practitioner or therapist, while the middle handle and upper massaging portions of the instrument are firmly held within the remaining fingers and palm. Such a grasp facilitates the practitioner""s applying pressure when engaging and moving the instrument along the skin of a patient.
A third embodiment of a diagnostic and therapeutic instrument provided by this invention includes a hand-held rigid unitary body having an upper surface, a lower surface disposed opposite from the upper surface, and opposing lateral surfaces. The upper and lower surfaces converge at a first end to define a tissue-engaging blunt edge generally coinciding with the intersection of the upper and lower surfaces. The upper and lower surfaces diverge at an opposing second end to define a comparatively larger second end disposed opposite from the first end. The opposing lateral surfaces extend vertically between the upper and lower surfaces and longitudinally between the first and second ends of the instrument. The second end extends vertically between the upper and lower surfaces and horizontally between the opposing lateral surfaces.
The upper surface is defined by a gradually convexly curved surface extending at least partially and longitudinally along the length of the instrument body between the first and second ends thereof. The lower surface can be defined by a gradually concavely curved surface extending at least partially and longitudinally along the length of the instrument between the first and second ends thereof.
In use of this third embodiment, the tissue-engaging blunt end of the instrument may be employed to engage and be moved along the skin of the patient to apply deep pressure to the underlying soft tissue.
The rehabilitation and therapeutic benefits accomplished by the use of the instruments provided by this invention have exceeded most expectations. Beneficial results have been achieved on musculoskeletal conditions that had previously been considered difficult, if not impossible, to treat. The use of these instruments provide a highly effective, non-invasive, low-cost treatment for post traumatic fibrosis, tendinitis, repetitive stress injuries and cumulative trauma disorders, by causing micro-trauma to the fibrotic soft tissue that allows the human body""s natural healing process to occur. Such soft tissue injuries may include both industrial and athletic injuries, such as Carpal Tunnel syndrome, tennis elbow, post ACL reconstruction, and other extremity problems. These instruments break down the scar tissue around and within the affected area and prevent the formation of new scar tissue.
These instruments often help patients get better without the need for surgery and the associated medical expense and lost time from the workplace or recreational activities. In the current environment of healthcare cost containment and the xe2x80x9cbundlingxe2x80x9d of pre- and post-operative care and treatment, the type of rehabilitation provided by the use of these instruments will prove to be extremely beneficial to the healthcare and insurance industries. Additional benefits include the need for surgery being reduced, patients no longer needing splints or braces or other modifications of their workplace environment, faster rehabilitation, recovery and normal functioning times for patients, and fewer visits with therapists being necessary than with traditional orthopedic and/or physical therapy treatments.
Other features and advantages of the invention will be apparent from the drawings and detailed description that follow.